Request No. __________________
Index Code
Pellissippi State Community College
Purpose of Trip
TRAVEL CLAIM
If claiming local mileage
For Instructions to complete claim please visit
www.pstcc.edu/finance/payable/procedures
DATE
PLACE LEFT
COMMENTS/TRAVEL CLERK
TIME
LEFT
PLACE ARRIVED
TIME
ARRIVE
MILES
LESS
NET MILEAGE
COMMUTE MILES AMOUNT
HOTEL
BREAKFAST
Account Code
Amount
_________ _________
_________
_________ _________
_________
_________ _________
_________
LUNCH
DINNER
PER DIEM
OTHER EXPENSE
(ITEMIZE & EXPLAIN)
TOTAL
Total Expenses
I hereby certify that this claim is true and correct. All expenses claimed
are for business purposes and, to the best of my knowledge, comply with
Less Prepaid
TBR travel policy.
Amount Due
Encumbrance Number:
Claimant Name (Please type or print)
Claimant Signature
Employee ID Number
Date
Administrative Approval
Travel Clerk
Date
Audited by
SUBMIT FOR APPROVAL/FORWARD TO ACCOUNTS PAYABLE
CMN-travelclaim
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